Summit Digs Into Salix Use, Regulation

Anyone hoping to learn the intricacies of Salix use, research, and regulation at the June 13 International Summit on Race Day Medication, EIPH and the Racehorse held at Belmont Park didn’t walk away disappointed.

Three Thoroughbred industry organizations put the summit together in response to federal bills filed the week of the Kentucky Derby Presented by Yum! Brands (gr. I) by U.S. Sen. Tom Udall of New Mexico and U.S. Rep. Ed Whitfield of Kentucky calling for a ban on all performance-enhancing drugs in horse racing and proposing a three-strikes-and-you’re-out-penalty system. Those organizations were the National Thoroughbred Racing Association, the American Association of Equine Practitioners, and the Racing Medication and Testing Consortium.

More than 100 people representing nine countries on six continents attended the conference.

Alex Waldrop, president and chief executive officer of the NTRA, said at the beginning of the summit anyone hoping to hear a debate might be disappointed.

“Our primary goal today is to inform,” he said. “Today these discussions are designed to promote interaction with our colleagues around the globe.”

Despite Waldrop’s qualifier that people passionately for or against the race-day use of furosemide (Salix) may not get to see debate, there was plenty of debate throughout the day. Salix is used to manage equine-induced pulmonary hemorrhaging, more commonly known as bleeding.

The use of Salix, all actions of Congress aside, is becoming more controversial because it’s perceived by the public as a legal form of drugging in racehorses. The medication is also controversial because it also perceived as a performance-enhancing drug.

Most of the back-and-forth regarding Salix’s use occurred during a series of three afternoon panel discussions; one panel with racing authority and registry executives from Hong Kong, Ireland and Great Britain; one panel with trainers; and one panel with veterinarians.

One of the most compelling presentations came from Bill Nader, former chief operating officer of the New York Racing Association and now executive director for the Hong Kong Jockey Club, a position he has held since 2007. Nader talked about how his perspective on Salix’ use changed after he moved to Hong Kong.

“I left New York in 2007 thinking (Salix) was part of racing,” he said. “It gives me no satisfaction to tell you day-to-day racing in Hong Kong is much better than racing in New York or California.”

Hong Kong racing is thriving, with wagering up 33% since 2006 to US$10.3 billion. The average field size is 12.5 horses per race, and the average starts per horse is 8.3.

“International harmonization (of medication rules) is very important to the Hong Kong Jockey Club,” Nader said. “We are looking for the world to come together. If this question of race-day medication was put to the Hong Kong public, as to the possible introduction of race-day medication, the answer would uniformly be: Why?”

The HKJC prohibits the use Salix on race day and in training. A horse that bleeds in a race must receive an official veterinary exam and is automatically banned from racing for three months.

If the horse bleeds again, it could be banned another three months or be forced to retire from racing. A third incident results in mandatory retirement from racing.

Nader’s comments were the counterbalance to a morning of presentation that largely supported a position that Salix is the most effective medication available for managing EIPH.

“The primary underlining problem (causing EIPH) is blood pressure, so a drug that reduces blood pressure is going to have the most benefit,” said Dr. Stephen Reed, who retired from Ohio State University as an emeritus professor and now works at Rood and Riddle Equine Hospital near Lexington. “The take-home message is that the only product that has shown significant improvement in treating EIPH is furosemide.”

Using Salix in a preventative way is equally important, several vets and trainers said, because it eliminates scarring in the lungs caused by the rupture of capillaries during intense exercise and avoids more profound incidents of bleeding.

If the horse bleeds, then right away you have a situation,” trainer Christophe Clement said. “You put him on clenbuterol. You need to do whatever you can to prevent the horse from continuing to bleed. Even if the scope is a grade one, I put them on three or four days of clenbuterol.

"The smaller you keep the lesions, then it won’t become chronic.”

Typically, the amount of bleeding in the trachea is scored between one and four, with four being a significant amount of blood coming from the lungs.

As to whether Salix is truly a performance-enhancing drug, there was a difference of opinion. Dr. Ed Robinson, director of Michigan State’s Equine Pulmonary Laboratory, said: “There is some question whether furosemide actually improves performance or just allows a horse to race to best of its ability.”

He reviewed research that showed how horses with EIPH scores of grade three or grade four run several lengths behind winning horses.

Dr. Treve Williams, retired senior partner and now consultant to the Randwick Equine Centre in Sydney, Australia, noted the widespread use of Salix in the U.S. indicates it has an effect on performance.

“You're giving Lasix (the former name of Salix) to 90% of your horses, and only 50% bleed,” Williams said. “It has been my experience that if trainers are willing to accept that level of treatment, then there is some performance-enhancement involved.”

Robert Manfred, executive vice president of Major League Baseball, kicked off the program with stories about how professional baseball has dealt over the years with its steroid scandal.

“First and most important, there is no winning the war against performance-enhancing substances,” Manfred said. “The best you can do is wage an effective battle against these kinds of substances, because at the end of the day it is cheating.”

His presentation was followed by an overview by Waldrop of the complicated debate surrounding the legal use of Salix on race day and a presentation of the most recent fan poll by Harvard University’s SocialSphere group.

“We had two NTRA board meetings that have been completely devoted to the discussion of race-day medication,” Waldrop said. “We could not reach consensus on this issue. I would suggest our board is a microcosm of the industry.”

John Della Volpe of with SocialSphere said the banning of anabolic steroids, the creation of the NTRA Safety and Integrity Alliance, and improvement of drug-testing protocols have significantly improved the sport's image among core fans who were polled in 2008 and again in 2009.

“What I know after 10 years of polling this industry and other sports is that your fans care deeply, deeply about this sport as much as any sport,” Della Volpe said. “They are educated. They are savvy technology-wise, and they desperately want you to succeed and want to help out in this process.”

He also said there is significant progress to be made.

“They are demanding transparency and authenticity,” Della Volpe said. “Whatever you do, do it collaboratively and do it with transparency.”

The summit continues at 8:30 a.m. EDT June 14. The second session will be facilitated discussions closed to the media. A media briefing will be held after the discussions.